Journal ArticleDOI
Effect of Dialysis Dose and Membrane Flux in Maintenance Hemodialysis
Garabed Eknoyan,Gerald J. Beck,Alfred K. Cheung,John T. Daugirdas,Tom Greene,John W. Kusek,Michael Allon,James L. Bailey,James A. Delmez,Thomas A. Depner,Johanna T. Dwyer,Andrew S. Levey,Nathan W. Levin,Edgar L. Milford,Daniel B. Ornt,Michael V. Rocco,Gerald Schulman,Steve J. Schwab,Brendan P. Teehan,Robert D. Toto +19 more
TLDR
Patients undergoing hemodialysis thrice weekly appear to have no major benefit from a higher dialysis dose than that recommended by current U.S. guidelines or from the use of a high-flux membrane.Abstract:
Background The effects of the dose of dialysis and the level of flux of the dialyzer membrane on mortality and morbidity among patients undergoing maintenance hemodialysis are uncertain. Methods We undertook a randomized clinical trial in 1846 patients undergoing thrice-weekly dialysis, using a two-by-two factorial design to assign patients randomly to a standard or high dose of dialysis and to a low-flux or high-flux dialyzer. Results In the standard-dose group, the mean (±SD) urea-reduction ratio was 66.3±2.5 percent, the single-pool Kt/V was 1.32±0.09, and the equilibrated Kt/V was 1.16±0.08; in the high-dose group, the values were 75.2±2.5 percent, 1.71±0.11, and 1.53±0.09, respectively. Flux, estimated on the basis of beta2-microglobulin clearance, was 3±7 ml per minute in the low-flux group and 34±11 ml per minute in the high-flux group. The primary outcome, death from any cause, was not significantly influenced by the dose or flux assignment: the relative risk of death in the high-dose group as com...read more
Citations
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Journal ArticleDOI
Mineral Metabolism, Mortality, and Morbidity in Maintenance Hemodialysis
Geoffrey A. Block,Preston S. Klassen,J. Michael Lazarus,Norma J. Ofsthun,Edmund G. Lowrie,Glenn M. Chertow +5 more
TL;DR: Hyperphosphatemia and hyperparathyroidism were significantly associated with all-cause, cardiovascular, and fracture-related hospitalization, and the population attributable risk percentage for disorders of mineral metabolism was 17.5%, owing largely to the high prevalence of hyperph phosphatemia.
Journal ArticleDOI
Correction of Anemia with Epoetin Alfa in Chronic Kidney Disease
Ajay K. Singh,Lynda A. Szczech,Kezhen L. Tang,Huiman X. Barnhart,Shelly Sapp,Marsha Wolfson,Donal N. Reddan,Abstr Act +7 more
TL;DR: The use of a target hemoglobin level of 13.5 g per deciliter (as compared with 11.3 g perDeciliter) was associated with increased risk and no incremental improvement in the quality of life and the use of epoetin alfa targeted to achieve a level of 11.4 g perdeciliter was not associated with an increased risk.
Journal ArticleDOI
Malnutrition-inflammation complex syndrome in dialysis patients: causes and consequences.
Kamyar Kalantar-Zadeh,Kamyar Kalantar-Zadeh,T. Alp Ikizler,Gladys Block,Morrel M. Avram,Joel D. Kopple,Joel D. Kopple,Joel D. Kopple +7 more
TL;DR: Because MICS leads to a low body mass index, hypocholesterolemia, hypocreatininemia, and hypohomocysteinemia, a "reverse epidemiology" of cardiovascular risks can occur in dialysis patients, obesity, hypercholesterolesmia, and increased blood levels of creatinine and homocysteine appear to be protective and paradoxically associated with a better outcome.
Journal ArticleDOI
In-center hemodialysis six times per week versus three times per week.
Glenn M. Chertow,Nathan W. Levin,Gerald J. Beck,Thomas A. Depner,Paul W. Eggers,Jennifer J. Gassman,Irina Gorodetskaya,Tom Greene,Sam James,Brett Larive,Robert M. Lindsay,Ravindra L. Mehta,Brent W. Miller,Daniel B. Ornt,Sanjay Rajagopalan,Anjay Rastogi,Michael V. Rocco,Brigitte Schiller,Olga Sergeyeva,Gerald Schulman,George Ting,Mark Unruh,Robert A. Star,Alan S. Kliger +23 more
TL;DR: Frequent hemodialysis, as compared with conventional hemodIALysis, was associated with favorable results with respect to the composite outcomes of death or change in left ventricular mass and death orchange in a physical-health composite score but prompted more frequent interventions related to vascular access.
Journal ArticleDOI
IL-10, IL-6, and TNF-α: Central factors in the altered cytokine network of uremia—The good, the bad, and the ugly
Peter Stenvinkel,Markus Ketteler,Richard J. Johnson,Bengt Lindholm,Roberto Pecoits-Filho,Miguel C. Riella,Olof Heimbürger,Tommy Cederholm,Matthias Girndt +8 more
TL;DR: Given the strong association between proinflammatory cytokines and complications common in end-stage renal disease, such as vascular calcification and wasting, the potential role of both general and targeted anticytokine treatment strategies in ESRD patients needs further evaluation.
References
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Journal ArticleDOI
The case for dialy dialysis: Its impact on costs and quality of life
Penny E. Mohr,Peter J. Neumann,Sheila J. Franco,Jonas Marainen,Robert S. Lockridge,George Ting +5 more
TL;DR: An economic evaluation comparing short daily or nocturnal hemodialysis with thrice-weekly conventional in-center dialysis and results suggest that patients feel better and direct treatment costs could be reduced with daily dialysis.
Journal ArticleDOI
Design and statistical issues of the hemodialysis (HEMO) study.
Tom Greene,Gerald J. Beck,Jennifer J. Gassman,Frank A. Gotch,John W. Kusek,Andrew S. Levey,Nathan W. Levin,Gerald Schulman,Garabed Eknoyan +8 more
TL;DR: The Hemodialysis Study is a multicenter clinical trial of hemodialysis prescriptions for patients with end stage renal disease randomized in a 2 x 2 factorial design to dialysis prescriptions targeted to a standard dose or a high dose, and to either low or high flux membranes.
Journal ArticleDOI
Survival in long-term haemodialysis patients: results from the annual survey of the Japanese Society for Dialysis Therapy.
Toru Shinzato,Shigeru Nakai,Takashi Akiba,C. Yamazaki,R. Sasaki,T. Kitaoka,Kazuo Kubo,Toshio Shinoda,Kiyoshi Kurokawa,F Marumo,Takashi Sato,Kei-ichiro Maeda +11 more
TL;DR: Evaluation of the death predictors for haemodialysis patients in Japan indicated that important death risk predictors were advanced age, occurrence of diabetes mellitus, male sex, and protein catabolic rate.
Journal ArticleDOI
Comparison of causes of death using HEMO study and HCFA end-stage renal disease death notification classification systems
Michael V. Rocco,Guofen Yan,Jennifer J. Gassman,Julia Breyer Lewis,Daniel B. Ornt,Barbara Weiss,Andrew S. Levey +6 more
TL;DR: Using the HEMO Study final death classification as the reference standard, most differences in the two classification systems were related to coding of heart disease, and studies using death classification from the HCFA ESRD death notification form should be interpreted cautiously.
Journal ArticleDOI
Effects of Hemodialyzer Reuse on Clearances of Urea and β2-Microglobulin
Alfred K. Cheung,Lawrence Y. Agodoa,John T. Daugirdas,Thomas A. Depner,Frank A. Gotch,Tom Greene,Nathan W. Levin,John K. Leypoldt +7 more
TL;DR: The data show that the effects of reuse on b2M are far more drastic than those on urea clearance, and the effects vary greatly depending on the dialysis membrane material and reprocessing reagents.
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